MDS 3.0 Resident Assessment Manual Chapter 1 Change ... - AANAC

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to Chapter 1 V1.11
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— — 1-2 IFMC Telligen
• Gloria Batts
• Debra Weiland, BSN, RN
• Jean Eby, BS
• Debra Cory, BS
• Kathy Langenberg, RN
— — 1-3 RTI International
• Roberta Constantine, RN, PhD
• Rajiv Ramakrishnan, BA
• Nathaniel Breg, BA
• Karen Reilly, Sc.D.
— — 1-4 Questions regarding information presented in this Manual should
be directed to your State’s RAI Coordinator. Please continue to
check our web site for more information at:
http://www.cms.gov/Medicare/Quality-Initiatives-Patient-
Assessment-
Instruments/NursingHomeQualityInits/MDS30RAIManual.htmlhtt
p://www.cms.gov/Medicare/Quality-Initiatives-Patient-
Assessment-
Instruments/NursingHomeQualityInits/Downloads/MDS30Appen
dix_B.pdf .
1 1.3 1-7 • Consumer Access to Nursing Home Information.
Consumers are also able to access information about every
Medicare- and/or Medicaid-certified nursing home in the
country. The Nursing Home Compare tool
(http://www.medicare.gov/nursinghomecompare/http://www.m
edicare.gov/NHCompare) provides public access to nursing
home characteristics, staffing and quality of care measures for
certified nursing homes.
1 1.8 1-16,
1-17
&
I-18
PRIVACY ACT STATEMENT – HEALTH CARE RECORDS
Long Term Care-Minimum Data Set (MDS) System of Records revised
04/28/2007
PRIVACY ACT STATEMENT – HEALTH CARE RECORDS (7/14/2005)
(Issued: 9-6-12, Implementation/Effective Date: 6-17-13)
THIS FORM PROVIDES YOU THE ADVICE REQUIRED BY THE
PRIVACY ACT OF 1974 (5 USC 552a). THIS FORM IS NOT A CONSENT
FORM TO RELEASE OR USE HEALTH CARE INFORMATION
PERTAINING TO YOU.
THIS FORM IS NOT A CONSENT FORM TO RELEASE OR USE HEALTH
CARE INFORMATION PERTAINING TO YOU.
1. AUTHORITY FOR COLLECTION OF INFORMATION,
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INCLUDING SOCIAL SECURITY NUMBER AND WHETHER
DISCLOSURE IS MANDATORY OR VOLUNTARY. Authority for
maintenance of the system is given under Sections 1102(a), 1819(b)(3)(A),
1819(f), 1919(b)(3)(A), 1919(f) and 1864 of the Social Security Act.
The system contains information on all residents of long-term care (LTC)
facilities that are Medicare and/or Medicaid certified, including private pay
individuals and not limited to Medicare enrollment and entitlement, and
Medicare Secondary Payer data containing other party liability insurance
information necessary for appropriate Medicare claim payment.
Medicare and Medicaid participating LTC facilities are required to conduct
comprehensive, accurate, standardized and reproducible assessments of each
resident's functional capacity and health status. To implement this requirement,
the facility must obtain information from every resident. This information is
also used by the Centers for Medicare & Medicaid Services (CMS) to ensure
that the facility meets quality standards and provides appropriate care to all
residents. 42 CFR §483.20, requires LTC facilities to establish a database, the
Minimum Data Set (MDS), of resident assessment information. The MDS data
are required to be electronically transmitted to the CMS National Repository.
Because the law requires disclosure of this information to Federal and State
sources as discussed above, a resident does not have the right to refuse consent
to these disclosures. These data are protected under the requirements of the
Federal Privacy Act of 1974 and the MDS LTC System of Records.
1. AUTHORITY FOR COLLECTION OF INFORMATION
INCLUDING SOCIAL SECURITY NUMBER (SSN)
Sections 1819(f), 1919(f), 1819(b)(3)(A), 1919(b)(3)(A), and 1864 of the
Social Security Act.
2. PRINCIPAL PURPOSES OF THE SYSTEM FOR WHICH
INFORMATION IS INTENDED TO BE USED. The primary purpose of
the system is to aid in the administration of the survey and certification, and
payment of Medicare/Medicaid LTC services which include skilled nursing
facilities (SNFs), nursing facilities (NFs) and non-critical access hospitals
with a swing bed agreement.
Information in this system is also used to study and improve the effectiveness
and quality of care given in these facilities. This system will only collect the
minimum amount of personal data necessary to achieve the purposes of the
MDS, reimbursement, policy and research functions.
2. PRINCIPAL PURPOSES FOR WHICH INFORMATION IS
INTENDED TO BE USED
This form provides you the advice required by The Privacy Act of 1974.
The personal information will facilitate tracking of changes in your
health and functional status over time for purposes of evaluating and
assuring the quality of care provided by nursing homes that participate in
Medicare or Medicaid.
3. ROUTINE USES OF RECORDS MAINTAINED IN THE SYSTEM.
The information collected will be entered into the LTC MDS System of
Records, System No. 09-70-0528. This system will only disclose the minimum
amount of personal data necessary to accomplish the purposes of the disclosure.
Information from this system may be disclosed to the following entities under
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specific circumstances (routine uses), which include:
(1) To support Agency contractors, consultants, or grantees who have been
contracted by the Agency to assist in accomplishment of a CMS
function relating to the purposes for this system and who need to have
access to the records in order to assist CMS;
(2) To assist another Federal or state agency, agency of a state government,
an agency established by state law, or its fiscal agent for purposes of
contributing to the accuracy of CMS’ proper payment of Medicare
benefits and to enable such agencies to fulfill a requirement of a
Federal statute or regulation that implements a health benefits program
funded in whole or in part with Federal funds and for the purposes of
determining, evaluating and/or assessing overall or aggregate cost,
effectiveness, and/or quality of health care services provided in the
State, and determine Medicare and/or Medicaid eligibility;
(3) To assist Quality Improvement Organizations (QIOs) in connection
with review of claims, or in connection with studies or other review
activities, conducted pursuant to Title XI or Title XVIII of the Social
Security Act and in performing affirmative outreach activities to
individuals for the purpose of establishing and maintaining their
entitlement to Medicare benefits or health insurance plans;
(4) To assist insurers and other entities or organizations that process
individual insurance claims or oversees administration of health care
services for coordination of benefits with the Medicare program and
for evaluating and monitoring Medicare claims information of
beneficiaries including proper reimbursement for services provided;
(5) To support an individual or organization to facilitate research,
evaluation, or epidemiological projects related to effectiveness, quality
of care, prevention of disease or disability, the restoration or
maintenance of health, or payment related projects;
(6) To support litigation involving the agency, this information may be
disclosed to The Department of Justice, courts or adjudicatory bodies;
(7) To support a national accrediting organization whose accredited
facilities meet certain Medicare requirements for inpatient hospital
(including swing beds) services;
(8) To assist a CMS contractor (including but not limited to fiscal
intermediaries and carriers) that assists in the administration of a CMSadministered
health benefits program, or to a grantee of a CMSadministered
grant program to combat fraud, waste and abuse in
certain health benefit programs; and
(9) To assist another Federal agency or to an instrumentality of any
governmental jurisdiction within or under the control of the United
States (including any state or local governmental agency), that
administers, or that has the authority to investigate potential fraud,
waste and abuse in a health benefits program funded in whole or in
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part by Federal funds.
3. ROUTINE USES
The primary use of this information is to aid in the administration of the
survey and certification of Medicare/Medicaid long-term care facilities
and to improve the effectiveness and quality of care given in those
facilities. This system will also support regulatory, reimbursement,
policy, and research functions. This system will collect the minimum
amount of personal data needed to accomplish its stated purpose.
The information collected will be entered into the Long-Term Care
Minimum Data Set (LTC MDS) system of records, System No. 09-70-
1517. Information from this system may be disclosed, under specific
circumstances (routine uses), which include: To the Census Bureau and
to: (1) Agency contractors, or consultants who have been engaged by the
Agency to assist in accomplishment of a CMS function, (2) another
Federal or State agency, agency of a State government, an agency
established by State law, or its fiscal agent to administer a Federal health
program or a Federal/State Medicaid program and to contribute to the
accuracy of reimbursement made for such programs, (3) to Quality
Improvement Organizations (QIOs) to perform Title XI or Title XVIII
functions, (4) to insurance companies, underwriters, third party
administrators (TPA), employers, self-insurers, group health plans, health
maintenance organizations (HMO) and other groups providing
protection against medical expenses to verify eligibility for coverage or
to coordinate benefits with the Medicare program, (5) an individual or
organization for a research, evaluation, or epidemiological project related
to the prevention of disease of disability, or the restoration of health, or
payment related projects, (6) to a member of Congress or congressional
staff member in response to an inquiry from a constituent, (7) to the
Department of Justice, (8) to a CMS contractor that assists in the
administration of a CMS-administered health benefits program or to a
grantee of a CMS-administered grant program, (9) to another Federal
agency or to an instrumentality of any governmental jurisdiction that
administers, or that has the authority to investigate potential fraud or
abuse in a health benefits program funded in whole or in part by Federal
funds to prevent, deter, and detect fraud and abuse in those programs,
(10) to national accrediting organizations, but only for those facilities
that these accredit and that participate in the Medicare program.
4. EFFECT ON INDIVIDUAL OF NOT PROVIDING INFORMATION.
The information contained in the LTC MDS System of Records is generally
necessary for the facility to provide appropriate and effective care to each
resident.
If a resident fails to provide such information, e.g. thorough medical history,
inappropriate and potentially harmful care may result. Moreover, payment for
services by Medicare, Medicaid and third parties, may not be available unless
the facility has sufficient information to identify the individual and support a
claim for payment.
NOTE: Residents or their representative must be supplied with a copy of the
notice. This notice may be included in the admission packet for all new nursing
home admissions, or distributed in other ways to residents or their
representative(s). Although signature of receipt is NOT required, providers may
request to have the Resident or his or her Representative sign a copy of this
notice as a means to document that notice was provided and merely
acknowledges that they have been provided with this information.
4. WHETHER DISCLOSURE IS MANDATORY OR VOLUNTARY
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AND EFFECT ON INDIVIDUAL OF NOT PROVIDING
INFORMATION
For Nursing Home residents residing in a certified Medicare/Medicaid
nursing facility the requested information is mandatory because of the
need to assess the effectiveness and quality of care given in certified
facilities and to assess the appropriateness of provided services. If the
requested information is not furnished the determination of beneficiary
services and resultant reimbursement may not be possible.Your signature
merely acknowledges that you have been advised of the foregoing. If
requested, a copy of this form will be furnished to you.
______________________________
Signature of Resident or Sponsor
__________________
Date
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